We recommend you also read the relevant Medicare Benefits Schedule (MBS) item descriptors and explanatory notes available at MBS Online website.

Bulk bill incentive eligibility requirements

Bulk bill incentive items can only be claimed where the item descriptor has been met. In general, if a health professional provides a bulk billed service or services to a patient, they can claim an additional MBS item or items where they meet the following conditions:

the service provided is an unreferred service, and

the service provided is for a person under the age of 16 or a Commonwealth concession card holder, and

the person isn't an admitted patient in a hospital, and

both the service and associated additional item are bulk billed

Where a Medicare benefit isn't payable for a particular service, for example, because the patient has exceeded the number of allowable services in a period of time, then the associated bulk bill incentive item is also not payable for that service.

Term

Explanation

Unreferred service

When either a medical, diagnostic imaging or pathology service is provided to a patient by, or on behalf of, a medical practitioner and the service hasn’t been referred to that practitioner by another medical practitioner or person with referring rights.

Commonwealth concession cardholder

A person listed on a:

Pensioner Concession Card

Health Care Card, or

Commonwealth Seniors Health Card

issued by either Centrelink or the Department of Veterans’ Affairs (DVA).

DVA Gold or White Cards aren’t recognised Commonwealth concession cards. If DVA Gold or White cardholders choose to be treated under Medicare arrangements, they must hold 1 of the concession cards listed above to be eligible.